Senior Clinical Pharmacy Technician – Medi-Cal Rx

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🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $19 - $28 / hour

⏰ Full Time

🟠 Senior

💊 Pharmacist

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

📋 Description

• Independently review, research, and resolve prior authorization requests using clinical criteria, established guidelines, and professional judgment within defined protocols • Communicate coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders • Manage inbound and outbound inquiries related to eligibility, benefits, claims, and prior authorizations • Escalate clinically complex or exception-based cases to a pharmacist with thorough documentation and relevant case context • Educate providers and members on claims submission processes, appeals requirements, and reimbursement guidelines across multiple networks • Initiate, prioritize, and manage cases by accurately gathering and entering member and provider information • Identify trends, root causes, high-risk inquiries, and workflow gaps, and recommend process improvements • Serve as a resource to team members by providing guidance, answering process questions, and supporting onboarding activities • Perform other duties as assigned

🎯 Requirements

• High school diploma from an accredited school or equivalent GED • 2 years of work experience as a pharmacy technician • Licensed Pharmacy Technician in accordance with California state requirements • Must be eligible to work in the United States without work visa or residency sponsorship • Strong knowledge of pharmacy workflows, terminology, and reimbursement processes • Ability to prioritize work and manage multiple assignments in a dynamic environment • Effective communication skills and ability to guide and support team members • Proficiency in pharmacy systems and Microsoft Office applications • Preferred: 1 year reimbursement experience • Preferred: PBM or health care experience • Must comply with job-specific security responsibilities, controls, legal, regulatory, contractual, and internal requirements • Must be able to perform the essential functions of the job

🏖️ Benefits

• Benefits, incentives, and additional compensation are available; the posting directs applicants to Prime’s Benefits Page for details • Reasonable accommodations for employees with disabilities • Equal opportunity and affirmative action employment • Tobacco-Free Workplace